Genitourinary Cancer

SS 41 - GU 5 - Discoveries for High Risk and Recurrent Prostate Cancer

300 - Hypofractionated Intensity Modulated Radiation Therapy to Prostate and Pelvic Nodes Plus Androgen Suppression in High-Risk Prostate Cancer

Wednesday, October 24
2:00 PM - 2:10 PM
Location: Room 214 A/B

Hypofractionated Intensity Modulated Radiation Therapy to Prostate and Pelvic Nodes Plus Androgen Suppression in High-Risk Prostate Cancer
S. L. Faria, F. Cury, M. Duclos, and L. Souhami; McGill University Health Centre, Montreal, QC, Canada

Purpose/Objective(s): A 20-fraction external beam hypofractionated course of radiation therapy to the prostate volume only has been shown in large, prospective randomized trials to be an effective strategy in low- and intermediate-risk prostate cancer patients. However, in those trials the pelvic nodes were not included in the target volumes. We report 5-year outcomes for high-risk prostate cancer patients treated with androgen suppression and 20-fraction hypofractionated radiation therapy (HypoRT) delivered to the prostate and the pelvic nodal areas

Materials/Methods: Patients with localized, high-risk prostate cancer (T3/4, or PSA >20 ng/ml, or Gleason score 8-10) were treated with a HypoRT regimen of 60 Gy in 20 fractions (4 weeks) to the prostate volume while the nodal areas received 44 Gy in 20 fractions delivered with intensity modulated radiation therapy (IMRT) with a simultaneous integrated boost technique. Image guided radiation treatment (IGRT) was performed daily in all patients. Androgen suppression started 2 to 3 months before HypoRT. After radiation therapy, patients were followed every 6 months with PSA, testosterone and imaging as needed. Toxicity was prospectively assessed and graded according to the CTCAEV3

Results: We reviewed the first consecutive 105 patients treated between October/2010 and December/2013. Median follow-up is 60 months (14-86). Median age is 72 years. Median androgen suppression duration is 18 months. The 5-year overall survival (OS) is 92% and the 5-year biochemical relapse free survival (bRFS) is 87%. The worst grade 2 or higher late GI or GU toxicity was seen in 7% and 9%, respectively. Grade 3 late GI or GU toxicity occurred in 2% of either site (see Table). There was no grade 4 or 5 toxicity

Conclusion: HypoRT delivered with IMRT in 20 fractions to the prostate and the pelvic nodes is practical and well tolerated. The preliminary 5-year outcomes compare with longer duration external beam radiation therapy (EBRT) using standard fractionation or EBRT combined with brachytherapy boost. HypoRT shortens total treatment duration, is cost-effective, convenient for patients and to the health system. These results support a randomized trial Table: compares McGill (present) results with 3 recent trials that used escalated radiation therapy doses and androgen suppression. Risk group: ASCENDE and DART01 trials included Intermediate and High-risk cases. 1) S Rodda et al. IJROBP 2017; 98:286; 2) Zapatero A et al. Lancet Oncol 2015;16:320; 3) Nabid A, et al. (abstract LBA4510) ASCO 2013 meeting.
Study Risk group Median age (years) hormonal duration (months) Median follow -up (years) 5-year OS 5-year bRFS Grade 3 late GI Grade 3 late GU
ASCENDE1 Int+High 68 12 6.5 91% 89%/84% 9% 19%
DART012 Int+High 71 4-24 5.2 95% 90%/81% 3% 3%
PCS IV3 High only 71 18-36 9.4 91% 80%/75% 1.3% 3%
McGill High only 72 6-24 5.0 92% 87% 2% 2%

Author Disclosure: S.L. Faria: None. F. Cury: None. M. Duclos: None. L. Souhami: Honoraria; Varian Medical Systems. Travel Expenses; Varian Medical Systems.

Sergio Faria, MD

Disclosure:
No relationships to disclose.

Biography:
Sergio Faria, MD, PhD, 66 yo originally from Sao Paulo, Brazil, working at McGill University, Radiation Oncology since 2001.
Graduated at University of Sao Paulo (USP) meidcal school in 1975. Resincy in Radiation Oncology until June 1979.
Fellowship at Stanford University in 1979- 1980.
PhD at University of Campinas in Campinas, SP, Brazil in 1991.

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